Provider Demographics
NPI:1902010978
Name:DAUGHERTY, DANIELLE NICHOLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:NICHOLE
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 KY HIGHWAY 36 E STE G6
Mailing Address - Street 2:
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-7493
Mailing Address - Country:US
Mailing Address - Phone:859-234-2777
Mailing Address - Fax:859-234-2775
Practice Address - Street 1:1210 KY HIGHWAY 36 E STE G6
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-7493
Practice Address - Country:US
Practice Address - Phone:859-234-2777
Practice Address - Fax:859-234-2775
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY012879OtherLICENSE